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Successful treatment of primary sclerosing cholangitis with a steroid and a probiotic.

Shimizu M, Iwasaki H, Mase S, Yachie A - Case Rep Gastroenterol (2012)

Bottom Line: Thus, the treatment of pediatric PSC remains a significant clinical challenge.This treatment provided benefits both for PSC and the undetermined colitis.These findings suggest that bacterial flora and gut inflammation are closely associated with the pathogenesis of inflammatory bowel disease-related PSC.

View Article: PubMed Central - PubMed

Affiliation: Department of Pediatrics, School of Medicine, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Kanazawa, Japan.

ABSTRACT
Primary sclerosing cholangitis (PSC) is a serious disease that not only affects quality of life but can also have a significant effect on patient survival. The treatment for PSC is primarily supportive with the aim of controlling cholestatic symptoms and preventing complications. Ursodeoxycholic acid may induce biochemical improvements in affected patients; however, long-term pediatric studies to determine its possible benefits in young patients are lacking. Thus, the treatment of pediatric PSC remains a significant clinical challenge. We describe a patient with PSC and undetermined colitis who was treated with a combination of a steroid, salazosulfapyridine, and a probiotic. This treatment provided benefits both for PSC and the undetermined colitis. These findings suggest that bacterial flora and gut inflammation are closely associated with the pathogenesis of inflammatory bowel disease-related PSC. Suppression of bowel inflammation and maintenance of bacterial homeostasis may be important for treating PSC.

No MeSH data available.


Related in: MedlinePlus

Pathological findings in PSC. a Magnetic resonance cholangiopancreatography showed an irregular contour of the intrahepatic bile duct. b, c The first liver biopsy revealed severe changes, including biliary tract outflow obstruction and chronic active inflammation involving the biliary tree (Azan staining; original magnification: b ×400, c ×100). d The second biopsy showed significant improvements in inflammatory cell infiltration and periductal fibrosis. Fibrotic areas had decreased from 10.5 to 3.6% in each specimen (Azan staining; original magnification: ×100).
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Figure 1: Pathological findings in PSC. a Magnetic resonance cholangiopancreatography showed an irregular contour of the intrahepatic bile duct. b, c The first liver biopsy revealed severe changes, including biliary tract outflow obstruction and chronic active inflammation involving the biliary tree (Azan staining; original magnification: b ×400, c ×100). d The second biopsy showed significant improvements in inflammatory cell infiltration and periductal fibrosis. Fibrotic areas had decreased from 10.5 to 3.6% in each specimen (Azan staining; original magnification: ×100).

Mentions: Magnetic resonance cholangiopancreatography showed an irregular contour of the intrahepatic bile duct (fig. 1a). A liver biopsy revealed severe biliary tract outflow obstruction and chronic active inflammation involving the biliary ducts (fig. 1b, c). Findings of hepatocellular involvement consistent with autoimmune hepatitis were not significant. Endoscopic retrograde cholangiography showed narrowing and irregularities of the intrahepatic bile ducts. A diagnosis of PSC associated with undetermined colitis was made.


Successful treatment of primary sclerosing cholangitis with a steroid and a probiotic.

Shimizu M, Iwasaki H, Mase S, Yachie A - Case Rep Gastroenterol (2012)

Pathological findings in PSC. a Magnetic resonance cholangiopancreatography showed an irregular contour of the intrahepatic bile duct. b, c The first liver biopsy revealed severe changes, including biliary tract outflow obstruction and chronic active inflammation involving the biliary tree (Azan staining; original magnification: b ×400, c ×100). d The second biopsy showed significant improvements in inflammatory cell infiltration and periductal fibrosis. Fibrotic areas had decreased from 10.5 to 3.6% in each specimen (Azan staining; original magnification: ×100).
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC3369409&req=5

Figure 1: Pathological findings in PSC. a Magnetic resonance cholangiopancreatography showed an irregular contour of the intrahepatic bile duct. b, c The first liver biopsy revealed severe changes, including biliary tract outflow obstruction and chronic active inflammation involving the biliary tree (Azan staining; original magnification: b ×400, c ×100). d The second biopsy showed significant improvements in inflammatory cell infiltration and periductal fibrosis. Fibrotic areas had decreased from 10.5 to 3.6% in each specimen (Azan staining; original magnification: ×100).
Mentions: Magnetic resonance cholangiopancreatography showed an irregular contour of the intrahepatic bile duct (fig. 1a). A liver biopsy revealed severe biliary tract outflow obstruction and chronic active inflammation involving the biliary ducts (fig. 1b, c). Findings of hepatocellular involvement consistent with autoimmune hepatitis were not significant. Endoscopic retrograde cholangiography showed narrowing and irregularities of the intrahepatic bile ducts. A diagnosis of PSC associated with undetermined colitis was made.

Bottom Line: Thus, the treatment of pediatric PSC remains a significant clinical challenge.This treatment provided benefits both for PSC and the undetermined colitis.These findings suggest that bacterial flora and gut inflammation are closely associated with the pathogenesis of inflammatory bowel disease-related PSC.

View Article: PubMed Central - PubMed

Affiliation: Department of Pediatrics, School of Medicine, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Kanazawa, Japan.

ABSTRACT
Primary sclerosing cholangitis (PSC) is a serious disease that not only affects quality of life but can also have a significant effect on patient survival. The treatment for PSC is primarily supportive with the aim of controlling cholestatic symptoms and preventing complications. Ursodeoxycholic acid may induce biochemical improvements in affected patients; however, long-term pediatric studies to determine its possible benefits in young patients are lacking. Thus, the treatment of pediatric PSC remains a significant clinical challenge. We describe a patient with PSC and undetermined colitis who was treated with a combination of a steroid, salazosulfapyridine, and a probiotic. This treatment provided benefits both for PSC and the undetermined colitis. These findings suggest that bacterial flora and gut inflammation are closely associated with the pathogenesis of inflammatory bowel disease-related PSC. Suppression of bowel inflammation and maintenance of bacterial homeostasis may be important for treating PSC.

No MeSH data available.


Related in: MedlinePlus